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Masika GM, Nyundo A, Msisiri L. Cognitive Impairment and the Associated Factors Among Older People in Rural Central Tanzania. Alzheimer Dis Assoc Disord 2023; 37:100-106. [PMID: 37253122 DOI: 10.1097/wad.0000000000000543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 12/28/2022] [Indexed: 06/01/2023]
Abstract
AIM This study examined the profile of cognitive impairment and associated factors among older people in rural central Tanzania. METHODS We conducted a cross-sectional study involving 462 community-dwelling older adults. We performed cognitive, psychosocial, and clinical assessments and face-to-face interviews with all older adults. Descriptive, bivariate and multivariate linear regression analyses were performed to determine the participant's cognitive performance and the associated factors. RESULTS The mean cognitive score on the Identification and Intervention for Dementia in Elderly Africans cognitive test was 11.04 (SD=2.89). Per the proposed cut-off scores to define probable and possible dementia, 13.2% of the population had probable dementia and another 13.9% had possible dementia. Increase in age was associated with poor cognitive performance (β=-0.076, 95% CI=-0.109 to -0.043, P<0.001); whereas male sex (β=0.989, 95% CI=0.333 to 1.645, P=0.003), higher educational attainment (β=2.575, 95% CI=0.557 to 4.594, P=0.013) and performance in instrumental activities of daily living (β=0.552, 95% CI=0.376 to 0.729, P<0.001) were associated with higher cognitive performance. DISCUSSION Older people in rural settings of central Tanzania have poor cognitive functions and are at high risk of further cognitive decline. Preventive and therapeutic programs for the affected older people are warranted to prevent further decline and maintain quality of life.
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Affiliation(s)
- Golden M Masika
- Department of Clinical Nursing School of Nursing and Public Health
| | - Azan Nyundo
- Department of Psychiatry, School of Medicine and Dentistry, University of Dodoma, Dodoma, Tanzania
| | - Laidi Msisiri
- Department of Clinical Nursing School of Nursing and Public Health
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Craig H, Gasevic D, Ryan J, Owen A, McNeil J, Woods R, Britt C, Ward S, Freak-Poli R. Socioeconomic, Behavioural, and Social Health Correlates of Optimism and Pessimism in Older Men and Women: A Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:3259. [PMID: 36833951 PMCID: PMC9961087 DOI: 10.3390/ijerph20043259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 02/08/2023] [Accepted: 02/08/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND Optimism is a disposition characterised by positive future expectancies, while pessimism is characterised by expecting the worst. High optimism and low pessimism promote the health of older adults and may potentiate full engagement in life. We identified socioeconomic, behavioural, and social factors associated with optimism and pessimism in older adults. METHODS Participants included 10,146 community-dwelling, apparently healthy Australian adults aged 70 years and over from the ASPREE Longitudinal Study of Older Persons (ALSOP). Optimism and pessimism were measured using the revised Life Orientation Test. Cross-sectional ordinal logistic regression was used to determine the socioeconomic, behavioural, and social health factors associated with optimism and pessimism. RESULTS Higher education, greater physical activity, lower loneliness, and volunteering were associated with higher optimism and lower pessimism. Low social support was associated with higher pessimism. Higher socioeconomic advantage, greater income, and living alone were associated with lower pessimism. Women were more optimistic and less pessimistic than men. The association of age, smoking status, and alcohol consumption with optimism and pessimism differed for men and women. CONCLUSIONS Factors associated with higher optimism and lower pessimism were also those demonstrated to support healthy ageing. Health-promotion action at the individual level (e.g., smoking cessation or regular physical activity), health professional level (e.g., social prescribing or improving access and quality of care for all older adults), and community level (e.g., opportunities for volunteer work or low-cost social activities for older adults) may improve optimism and reduce pessimism, possibly also promoting healthy ageing.
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Affiliation(s)
- Heather Craig
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia
| | - Danijela Gasevic
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia
- Centre for Global Health, Usher Institute, University of Edinburgh, Teviot Place, Edinburgh EH8 9AG, UK
| | - Joanne Ryan
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia
| | - Alice Owen
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia
| | - John McNeil
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia
| | - Robyn Woods
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia
| | - Carlene Britt
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia
| | - Stephanie Ward
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia
- Centre for Healthy Brain Ageing, School of Psychiatry, University of New South Wales, Sydney, NSW 2052, Australia
- Department of Geriatric Medicine, Prince of Wales Hospital, Randwick, NSW 2031, Australia
| | - Rosanne Freak-Poli
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia
- School of Clinical Sciences at Monash Health, Monash University, Melbourne, VIC 3004, Australia
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A longitudinal study on the impact of parental academic support and expectations on students’ academic achievement: the mediating role of happiness. EUROPEAN JOURNAL OF PSYCHOLOGY OF EDUCATION 2022. [DOI: 10.1007/s10212-022-00608-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Alseminy MAMM, Chandrasekaran B, Bairapareddy KC. Association of Physical Activity and Quality of Life with Work-Related Musculoskeletal Disorders in the UAE Young Adults. Healthcare (Basel) 2022; 10:healthcare10040625. [PMID: 35455803 PMCID: PMC9028778 DOI: 10.3390/healthcare10040625] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 03/16/2022] [Accepted: 03/22/2022] [Indexed: 02/01/2023] Open
Abstract
Background: Work-related musculoskeletal disorders (WRMSDs) pose threat to the global economy and work productivity. Though growing evidence shows physical activity and quality of life are major determinants for WRMSDs, the association between physical activity and the quality of life among the young adults of the United Arab Emirates (UAE) remains unclear. Methods: In a cross-sectional study, a total of 507 young adults who were between the ages 18–35 years were administered an interviewer-based survey on musculoskeletal disorders, physical activity, and quality of life. The association between the potential determinants and the WRMSDs was analyzed using linear and logistic regression models. Results: High prevalence (75%) of WRMSDs was found among the UAE young adults. Participants with low leisure-time physical activity had few WRMSDs. There was no significant association between physical activity or quality-of-life scores with the incidence of WRMSDs although physical activity time was highly associated with the quality of life, especially the social domain. Conclusion: Though a high prevalence of WRMSDs among UAE men and women was found, neither physical activity nor the quality-of-life scores determined the incidence of WRMSDs.
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Affiliation(s)
| | - Baskaran Chandrasekaran
- Department of Exercise Science & Sports, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal 576104, India;
| | - Kalyana Chakravarthy Bairapareddy
- Department of Physiotherapy, College of Health Sciences, University of Sharjah, Sharjah 27272, United Arab Emirates;
- Correspondence:
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Santini ZI, Pisinger VSC, Nielsen L, Madsen KR, Nelausen MK, Koyanagi A, Koushede V, Roffey S, Thygesen LC, Meilstrup C. Social Disconnectedness, Loneliness, and Mental Health Among Adolescents in Danish High Schools: A Nationwide Cross-Sectional Study. Front Behav Neurosci 2021; 15:632906. [PMID: 33927599 PMCID: PMC8078177 DOI: 10.3389/fnbeh.2021.632906] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 03/12/2021] [Indexed: 01/19/2023] Open
Abstract
Background: Previous research has suggested that social disconnectedness experienced at school is linked to mental health problems, however, more research is needed to investigate (1) whether the accumulation of various types of social disconnectedness is associated with risk for mental health problems, and (2) whether loneliness is a mechanism that explains these associations. Methods: Using data from the Danish National Youth Study 2019 (UNG19), nation-wide cross-sectional data from 29,086 high school students in Denmark were analyzed to assess associations between social disconnectedness experienced at school (lack of classmate support, lack of teacher support, lack of class social cohesion, and not being part of the school community) and various mental health outcomes, as well as the mediating role of loneliness for each type of disconnectedness. Multilevel regression analyses were conducted to assess the associations. Results: Descriptive analyses suggest that 27.5% of Danish high school students experience at least one type of social disconnectedness at school. Each type of social disconnectedness was positively associated with mental health problems (depression symptoms, anxiety symptoms, stress, sleep problems, suicidal ideation, non-suicidal self-injury, eating disorder, body dissatisfaction, and low self-esteem) and negatively associated with mental well-being. In all cases, loneliness significantly mediated the associations. We found a clear dose-response pattern, where each addition in types of social disconnectedness was associated with (1) stronger negative coefficients with mental well-being and (2) stronger positive coefficients with mental health problems. Conclusion: Our results add to a large evidence-base suggesting that mental health problems among adolescents may be prevented by promoting social connectedness at school. More specifically, fostering social connectedness at school may prevent loneliness, which in turn may promote mental well-being and prevent mental health problems during the developmental stages of adolescence. It is important to note that focusing on single indicators of school social connectedness/disconnectedness would appear to be insufficient. Implications for practices within school settings to enhance social connectedness are discussed.
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Affiliation(s)
- Ziggi Ivan Santini
- The National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Veronica S. C. Pisinger
- The National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Line Nielsen
- The National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Katrine Rich Madsen
- The National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | | | - Ai Koyanagi
- Parc Sanitari Sant Joan de Déu, Universitat de Barcelona, Fundació Sant Joan de Déu, Centro de Investigación Biomédica en Red de Salud Mental, Dr. Antoni Pujadas, 42, Barcelona, Spain
- Institució Catalana de Recerca i Estudis Avançats, Barcelona, Spain
| | - Vibeke Koushede
- Department of Psychology, University of Copenhagen, Copenhagen, Denmark
| | - Sue Roffey
- Educational Psychology, University College London, London, United Kingdom
- School of Education, Western Sydney University, Penrith, NSW, Australia
| | - Lau C. Thygesen
- The National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
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Chen YH, Karimi M, Rutten-van Mölken MPMH. The disease burden of multimorbidity and its interaction with educational level. PLoS One 2020; 15:e0243275. [PMID: 33270760 PMCID: PMC7714131 DOI: 10.1371/journal.pone.0243275] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Accepted: 11/18/2020] [Indexed: 12/21/2022] Open
Abstract
Introduction Policies to adequately respond to the rise in multimorbidity have top-priority. To understand the actual burden of multimorbidity, this study aimed to: 1) estimate the trend in prevalence of multimorbidity in the Netherlands, 2) study the association between multimorbidity and physical and mental health outcomes and healthcare cost, and 3) investigate how the association between multimorbidity and health outcomes interacts with socio-economic status (SES). Methods Prevalence estimates were obtained from a nationally representative pharmacy database over 2007–2016. Impact on costs was estimated in a fixed effect regression model on claims data over 2009–2015. Data on physical and mental health and SES were obtained from the National Health Survey in 2017, in which the Katz-10 was used to measure limitations in activities of daily living (ADL) and the Mental Health Inventory (MHI) to measure mental health. SES was approximated by the level of education. Generalized linear models (2-part models for ADL) were used to analyze the health data. In all models an indicator variable for the presence or absence of multimorbidity was included or a categorical variable for the number of chronic conditions. Interactions terms of multimorbidity and educational level were added into the previously mentioned models. Results Over the past ten years, there was an increase of 1.6%-point in the percentage of people with multimorbidity. The percentage of people with three or more conditions increased with +2.1%-point. People with multimorbidity had considerably worse physical and mental health outcomes than people without multimorbidity. For the ADL, the impact of multimorbidity was three times greater in the lowest educational level than in the highest educational level. For the MHI, the impact of multimorbidity was two times greater in the lowest than in the highest educational level. Each additional chronic condition was associated with a greater worsening in health outcomes. Similarly, for costs, where there was no evidence of a diminishing impact of additional conditions either. In patients with multimorbidity total healthcare costs were on average €874 higher than in patients with a single morbidity. Conclusion The impact of multimorbidity on health and costs seems to be greater in the sicker and lower educated population.
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Affiliation(s)
- Yi Hsuan Chen
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
- * E-mail:
| | - Milad Karimi
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Maureen P. M. H. Rutten-van Mölken
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
- Institute for Medical Technology Assessment, Erasmus University Rotterdam, Rotterdam, The Netherlands
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Behavioral and psychological health inequities in income disparate perimenopausal women: a brief report. ACTA ACUST UNITED AC 2020; 28:86-92. [PMID: 32898022 DOI: 10.1097/gme.0000000000001650] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To assess differences in behavioral and psychological health characteristics in perimenopausal women delineated by income disparity. METHODS A hypothesis generating secondary data analysis was conducted in 33 women, using public health insurance enrollment as a proxy for income. Sociodemographic characteristics were assessed. Study outcomes included behavioral health characteristics: current cigarette smoking, substance abuse history, current exercise, obesity (BMI ≥30); psychological health characteristics, and sleep: depressed mood (Center for Epidemiologic Studies Depression Scale [CES-D]), anxiety (Generalized Anxiety Disorder-7 [GAD-7]), and sleep (Insomnia Severity Index [ISI]). Group comparisons were assessed via the Student t test, Wilcoxon Rank-Sum test or Chi-square test, and multivariable models. RESULTS Forty-two percent (n = 14) were designated as income disparate, and sociodemographic characteristics were similar between groups; nearly half were Black/African American. More income disparate women reported current cigarette smoking [71% (10) vs 21%(4), P = 0.004] and substance abuse history [79%(11) vs 5%(1), P < 0.0001]. Fewer income disparate women reported current exercise [57%(8) vs 89%(17), P = 0.03] and more were obese [BMI ≥30; 50%(7) vs 11%(2), P = 0.01]. Income disparate women experienced significantly higher CES-D scores [13.5 (11.75, 23.75) vs 6 (0, 9), P < 0.0001], GAD-7 scores [5.5 (2, 8.75) vs 2 (0, 4), P = 0.04], and ISI scores [11 (5.55) vs 5 (4.36), P = 0.004]. CONCLUSIONS Findings from this preliminary analysis evidence inequities in behavioral, psychological, and sleep characteristics in perimenopausal women. Awareness of how the social determinants of health impact outcomes among vulnerable perimenopausal women is critical to developing equitable aging opportunities, including customized preventive health screenings and interventions that engage income disparate perimenopausal women.
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Pepito VCF, Newton S. Determinants of HIV testing among Filipino women: Results from the 2013 Philippine National Demographic and Health Survey. PLoS One 2020; 15:e0232620. [PMID: 32396559 PMCID: PMC7217462 DOI: 10.1371/journal.pone.0232620] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Accepted: 04/17/2020] [Indexed: 11/25/2022] Open
Abstract
Background The prevalence of having ever tested for HIV in the Philippines is very low and is far from the 90% target of the Philippine Department of Health (DOH) and UNAIDS, thus the need to identify the factors associated with ever testing for HIV among Filipino women. Methods We analysed the 2013 Philippine National Demographic and Health Survey (NDHS). The NDHS is a nationally representative survey which utilized a two-stage stratified design to sample Filipino women aged 15–49. We considered the following exposures in our study: socio-demographic characteristics of respondent and her partner (i.e., age of respondent, age of partner, wealth index, etc.), sexual practices and contraception (i.e., age at first intercourse, condom use, etc.), media access, tobacco use, HIV knowledge, tolerance to domestic violence, and women’s empowerment. The outcome variable is HIV testing. We used logistic regression for survey data to study the said associations. Results Out of 16,155 respondents, only 372 (2.4%) have ever tested for HIV. After adjusting for confounders, having tertiary education (adjusted odds ratio (aOR) = 2.15; 95% Confidence Interval (CI): 1.15–4.04), living with partner (aOR = 1.72; 95% CI: 1.19–2.48), tobacco use (aOR = 1.87; 95% CI: 1.13–3.11); belonging to the middle class (aOR = 2.72; 95% CI: 1.30–5.67), richer (aOR = 3.00; 95% CI: 1.37–5.68), and richest (aOR = 4.14; 95% CI: 1.80–5.91) populations, having weekly television access (aOR = 1.75; 95% CI: 1.04–2.94) or internet access (aOR = 2.01; 95% CI: 1.35–3.00), living in a rural area (aOR = 1.87; 95% CI: 1.34–2.61); and being a Muslim (aOR = 2.30; 95% CI: 1.15–4.57) were associated with ever testing for HIV. Conclusions The low percentage of respondents who test for HIV is a call to further strengthen efforts to promote HIV testing among Filipino women. Information on its determinants can be used to guide the crafting and implementation of interventions to promote HIV testing to meet DOH and UNAIDS targets.
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Affiliation(s)
- Veincent Christian F. Pepito
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, University of London, London, United Kingdom
- Center for Research and Innovation, School of Medicine and Public Health, Ateneo de Manila University, Pasig City, Philippines
- * E-mail:
| | - Sam Newton
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, University of London, London, United Kingdom
- School of Public Health, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
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Borst RAJ, Hoekstra T, Muhangi D, Jonker I, Kok MO. Reaching rural communities through 'Healthy Entrepreneurs': a cross-sectional exploration of community health entrepreneurship's role in sexual and reproductive health. Health Policy Plan 2020; 34:676-683. [PMID: 31774511 PMCID: PMC6880333 DOI: 10.1093/heapol/czz091] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/22/2019] [Indexed: 11/19/2022] Open
Abstract
The purpose of the current study was to explore the association between community health entrepreneurship and the sexual and reproductive health status of rural households in West-Uganda. We collected data using digital surveys in a cluster-randomized cross-sectional cohort study. The sample entailed 1211 household members from 25 randomly selected villages within two subcounties, of a rural West-Ugandan district. The association between five validated sexual and reproductive health outcome indicators and exposure to community health entrepreneurship was assessed using wealth-adjusted mixed-effects logistic regression models. We observed that households living in an area where community health entrepreneurs were active reported more often to use at least one modern contraceptive method [odds ratios (OR): 2.01, 95% CI: 1.30–3.10] had more knowledge of modern contraceptive methods (OR: 7.75, 95% CI: 2.81–21.34), knew more sexually transmitted infections (OR: 1.86, 95% CI: 1.14–3.05), and mentioned more symptoms of sexually transmitted infections (OR: 1.83, 95% CI: 1.18–2.85). The association between exposure to community health entrepreneurship and communities’ comprehensive knowledge of HIV/AIDS was more ambiguous (OR: 1.27, 95% CI: 0.97–1.67). To conclude, households living in areas where community health entrepreneurs were active had higher odds on using modern contraceptives and had more knowledge of modern contraceptive methods, sexually transmitted infections and symptoms of sexually transmitted infections. This study provides the first evidence supporting the role of community health entrepreneurship in providing rural communities with sexual and reproductive health care.
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Affiliation(s)
- Robert A J Borst
- Erasmus School of Health Policy & Management, Health Care Governance, Erasmus University Rotterdam, DR Rotterdam, The Netherlands
| | - Trynke Hoekstra
- Department of Health Sciences, Faculty of Science, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, De Boelelaan 1085, HV, Amsterdam, The Netherlands
| | - Denis Muhangi
- Department of Social Work and Social Administration, Makerere University, Kampala, Uganda
| | - Isis Jonker
- Department of Health Sciences, Faculty of Science, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, De Boelelaan 1085, HV, Amsterdam, The Netherlands
| | - Maarten Olivier Kok
- Erasmus School of Health Policy & Management, Health Care Governance, Erasmus University Rotterdam, DR Rotterdam, The Netherlands.,Department of Health Sciences, Faculty of Science, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, De Boelelaan 1085, HV, Amsterdam, The Netherlands
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Bornemann-Cimenti H, Szilagyi IS. Limitations, Transparency, and Conclusions. JAMA FACIAL PLAST SU 2018; 20:337-338. [DOI: 10.1001/jamafacial.2017.2437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Helmar Bornemann-Cimenti
- Department of Anesthesiology and Intensive Care Medicine, Medical University Graz, Graz, Austria
| | - Istvan S. Szilagyi
- Department of Anesthesiology and Intensive Care Medicine, Medical University Graz, Graz, Austria
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Harris L, Melville C, Murray H, Hankey C. The effects of multi-component weight management interventions on weight loss in adults with intellectual disabilities and obesity: A systematic review and meta-analysis of randomised controlled trials. RESEARCH IN DEVELOPMENTAL DISABILITIES 2018; 72:42-55. [PMID: 29107176 DOI: 10.1016/j.ridd.2017.10.021] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Revised: 10/20/2017] [Accepted: 10/21/2017] [Indexed: 06/07/2023]
Abstract
BACKGROUND Adults with intellectual disabilities have been shown to experience higher rates of obesity in comparison to the general population. AIM To examine the effectiveness of randomised controlled trials of multi-component weight management interventions for adults with intellectual disabilities and overweight/obesity. METHODS AND PROCEDURES A systematic search of six electronic databases was conducted from database inception to January 2016. Risk of bias was assessed by the Cochrane Collaboration tool. Behavioural change techniques were defined by coding against the Coventry Aberdeen LOndon REfined (CALO-RE) taxonomy. Meta-analyses were conducted as Weighted Mean Difference (WMD) between intervention and control/comparator intervention. OUTCOMES AND RESULTS Six randomised controlled trials were included. The interventions did not adhere to clinical recommendations [the inclusion of an energy deficit diet (EDD), physical activity, and behaviour change techniques]. Meta-analysis revealed that current multi-component weight management interventions are not more effective than no treatment (WMD: -0.38kg; 95% CI -1.34kg to 0.58kg; p=0.44). CONCLUSION AND IMPLICATIONS There is a paucity of randomised controlled trials of multi-component weight management interventions for adults with intellectual disabilities and overweight/obesity. Current interventions, based on a health education approach are ineffective. Future long-term interventions that include an EDD and adhere to clinical recommendations on the management of obesity are warranted.
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Affiliation(s)
- Leanne Harris
- College of Medical Veterinary and Life Sciences, Institute of Mental Health & Wellbeing, University of Glasgow, Glasgow G12 0XH, UK.
| | - Craig Melville
- College of Medical Veterinary and Life Sciences, Institute of Mental Health & Wellbeing, University of Glasgow, Glasgow G12 0XH, UK.
| | - Heather Murray
- Robertson Centre for Biostatistics, Institute of Health and Wellbeing, University of Glasgow, Glasgow G12 8QQ, UK.
| | - Catherine Hankey
- College of Medical Veterinary and Life Sciences, Institute of Health & Wellbeing, University of Glasgow, Glasgow G31 2ER, UK.
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Combination of ALDH2 and ADH1B polymorphisms is associated with smoking initiation: A large-scale cross-sectional study in a Japanese population. Drug Alcohol Depend 2017; 173:85-91. [PMID: 28212515 DOI: 10.1016/j.drugalcdep.2016.12.015] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2016] [Revised: 12/06/2016] [Accepted: 12/13/2016] [Indexed: 11/24/2022]
Abstract
BACKGROUND Aldehyde dehydrogenase 2 (ALDH2; rs671, Glu504Lys) and alcohol dehydrogenase 1B (ADH1B; rs1229984, His47Arg) polymorphisms are known to strongly influence alcohol drinking behavior. Given evidence of an association between smoking and drinking behaviors, we hypothesized that ALDH2/ADH1B polymorphisms might also be associated with smoking initiation, and conducted a cross-sectional study to examine this hypothesis. METHODS Study subjects were first-visit outpatients diagnosed not to have cancer at Aichi Cancer Center Hospital between 2001 and 2005, including 4141 never smokers and 2912 ever smokers. Unconditional logistic regression models were applied to estimate odds ratios (OR) and 95% confidence intervals (CI) for smoking initiation by comparing ever smokers with never smokers. RESULTS Excessive alcohol drinking was associated with a higher likelihood of ever smoking. After adjustment for drinking behaviors, compared to individuals with ALDH2 Glu/Glu, the ORs of ever smoking were 1.71 (95% CI, 1.49-1.95) and 2.28 (1.81-2.87) among those with ALDH2 Glu/Lys and Lys/Lys, respectively. Combination of ALDH2 Lys/Lys and ADH1B His/His (i.e., the most alcohol-intolerant subpopulation) showed the highest OR [2.44 (1.84-3.23)], whereas combination of ALDH2 Glu/Glu and ADH1B Arg/Arg (i.e., the most alcohol-tolerant subpopulation) showed the lowest OR [0.83 (0.57-1.21)] compared with ALDH2 Glu/Glu and ADH1B His/His. CONCLUSION Besides the amount and frequency of alcohol drinking, the combination of ALDH2 and ADH1B polymorphisms predicts smoking initiation. This study suggests that alcohol tolerance regulated by ALDH2 and ADH1B polymorphisms is associated with smoking initiation, and facilitates the development of targeted interventions to reduce smoking prevalence.
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de Andrade KRC, Silva MT, Galvão TF, Pereira MG. Functional disability of adults in Brazil: prevalence and associated factors. Rev Saude Publica 2016; 49:S0034-89102015000100268. [PMID: 26759965 PMCID: PMC4687823 DOI: 10.1590/s0034-8910.2015049005945] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2014] [Accepted: 03/27/2015] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE To estimate the prevalence and factors associated with functional disability in adults in Brazil. METHODS We used information from the health supplement of the National Household Sample Survey in 2008. The dependent variable was the functional disability among adults of 18 to 65 years, measured by the difficulty of walking about 100 meters; independent variables were: health plan membership, region of residence, state of domicile, education level, household income, economic activity, self-perception of health, hospitalization, chronic diseases, age group, sex, and color. We calculated the gross odds ratios (OR), and their respective confidence intervals (95%), and adjusted them for variables of study by ordinal logistic regression, following hierarchical model. Sample weights were considered in all calculations. RESULTS We included 18,745 subjects, 74.0% of whom were women. More than a third of adults reported having functional disability. The disability was significantly higher among men (OR = 1.17; 95%CI 1.09;1.27), people from 35 to 49 years (OR = 1.30; 95%CI 1.17;1.45) and 50 to 65 years (OR = 1.38; 95%CI 1.24;1.54); economically inactive individuals (OR = 2.21; 95%CI 1.65;2.96); adults who reported heart disease (OR = 1.13; 95%CI 1.03;1.24), diabetes mellitus (OR = 1.16; 95%CI 1.05;1.29), arterial systemic hypertension (OR = 1.10; 95%CI 1.02;1.18), and arthritis/rheumatism (OR = 1.24; 95%CI 1.15;1.34); and participants who were admitted in the last 12 months (OR = 2.35; 95%CI 1.73;3.2). CONCLUSIONS Functional disability is common among Brazilian adults. Hospitalization is the most strongly associated factor, followed by economic activity, and chronic diseases. Sex, age, education, and income are also associated. Results indicate specific targets for actions that address the main factors associated with functional disabilities and contribute to the projection of interventions for the improvement of the well-being and promotion of adults' quality of life.
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Affiliation(s)
| | | | - Taís Freire Galvão
- Hospital Universitário Getúlio Vargas. Universidade Federal do Amazonas. Manaus, AM, Brasil
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Noordraven EL, Wierdsma AI, Blanken P, Bloemendaal AF, Mulder CL. Depot-medication compliance for patients with psychotic disorders: the importance of illness insight and treatment motivation. Neuropsychiatr Dis Treat 2016; 12:269-74. [PMID: 26893565 PMCID: PMC4745949 DOI: 10.2147/ndt.s97883] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Noncompliance is a major problem for patients with a psychotic disorder. Two important risk factors for noncompliance that have a severe negative impact on treatment outcomes are impaired illness insight and lack of motivation. Our cross-sectional study explored how they are related to each other and their compliance with depot medication. METHODS Interviews were conducted in 169 outpatients with a psychotic disorder taking depot medication. Four patient groups were defined based on low or high illness insight and on low or high motivation. The associations between depot-medication compliance, motivation, and insight were illustrated using generalized linear models. RESULTS Generalized linear model showed a significant interaction effect between motivation and insight. Patients with poor insight and high motivation for treatment were more compliant (94%) (95% confidence interval [CI]: 1.821, 3.489) with their depot medication than patients with poor insight and low motivation (61%) (95% CI: 0.288, 0.615). Patients with both insight and high motivation for treatment were less compliant (73%) (95% CI: 0.719, 1.315) than those with poor insight and high motivation. CONCLUSION Motivation for treatment was more strongly associated with depot-medication compliance than with illness insight. Being motivated to take medication, whether to get better or for other reasons, may be a more important factor than having illness insight in terms of improving depot-medication compliance. Possible implications for clinical practice are discussed.
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Affiliation(s)
- Ernst L Noordraven
- Dual Diagnosis Centre (CDP), Parnassia Psychiatric Institute, the Hague, the Netherlands; Department of Psychiatry, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - André I Wierdsma
- Department of Psychiatry, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Peter Blanken
- Parnassia Addiction Research Centre (PARC), Parnassia Psychiatric Institute, the Hague
| | - Anthony Ft Bloemendaal
- Dual Diagnosis Centre (CDP), Parnassia Psychiatric Institute, the Hague, the Netherlands
| | - Cornelis L Mulder
- Department of Psychiatry, Erasmus University Medical Center, Rotterdam, the Netherlands; Bavo-Europoort Mental Health Care, Parnassia Psychiatric Institute, Rotterdam, the Netherlands
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Ghimire S, Castelino RL, Lioufas NM, Peterson GM, Zaidi STR. Nonadherence to Medication Therapy in Haemodialysis Patients: A Systematic Review. PLoS One 2015; 10:e0144119. [PMID: 26636968 PMCID: PMC4670103 DOI: 10.1371/journal.pone.0144119] [Citation(s) in RCA: 128] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2015] [Accepted: 11/15/2015] [Indexed: 11/19/2022] Open
Abstract
Background End-stage kidney disease (ESKD) patients are often prescribed multiple medications. Together with a demanding weekly schedule of dialysis sessions, increased number of medicines and associated regimen complexity pre-dispose them at high risk of medication nonadherence. This review summarizes existing literature on nonadherence and identifies factors associated with nonadherence to medication therapy in patients undergoing haemodialysis. Methods A comprehensive search of PubMed, Embase, CINAHL, PsycInfo, and Cochrane Database of Systematic Reviews covering the period from 1970 through November 2014 was performed following a predefined inclusion and exclusion criteria. Reference lists from relevant materials were reviewed. Data on study characteristics, measures of nonadherence, prevalence rates and factors associated with nonadherence were collected. The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines was followed in conducting this systematic review. Results Of 920 relevant publications, 44 were included. The prevalence of medication nonadherence varied from 12.5% to 98.6%, with widespread heterogeneity in measures and definitions employed. Most common patient-related factors significantly associated with nonadherence were younger age, non-Caucasian ethnicity, illness interfering family life, being a smoker, and living single and being divorced or widowed. Similarly, disease-related factors include longevity of haemodialysis, recurrent hospitalization, depressive symptoms and having concomitant illness like diabetes and hypertension. Medication-related factors such as daily tablet count, total pill burden, number of phosphate binders prescribed and complexity of medication regimen were also associated with poor adherence. Conclusions A number of patient-, disease-, and medication-related factors are associated with medication nonadherence in haemodialysis patients. Clinicians should be aware of such factors so that adherence to medications can be optimised in haemodialysis patients. Future research should be directed towards well-designed prospective longitudinal studies developing standard definitions and validating available measurement tools, while focusing on the role of additional factors such as psychosocial and behavioural factors in predicting nonadherence to medications.
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Affiliation(s)
- Saurav Ghimire
- Unit for Medication Outcomes Research and Education, Pharmacy, School of Medicine, Faculty of Health, University of Tasmania, Hobart, Australia
| | - Ronald L. Castelino
- Unit for Medication Outcomes Research and Education, Pharmacy, School of Medicine, Faculty of Health, University of Tasmania, Hobart, Australia
| | | | - Gregory M. Peterson
- Unit for Medication Outcomes Research and Education, Pharmacy, School of Medicine, Faculty of Health, University of Tasmania, Hobart, Australia
| | - Syed Tabish R. Zaidi
- Unit for Medication Outcomes Research and Education, Pharmacy, School of Medicine, Faculty of Health, University of Tasmania, Hobart, Australia
- * E-mail:
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Goodman M, Narayan KMV, Flanders D, Chang ET, Adami HO, Boffetta P, Mandel JS. Dose-response relationship between serum 2,3,7,8-tetrachlorodibenzo-p-dioxin and diabetes mellitus: a meta-analysis. Am J Epidemiol 2015; 181:374-84. [PMID: 25731889 PMCID: PMC4380020 DOI: 10.1093/aje/kwu307] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
We systematically evaluated studies published through May 2014 in which investigators assessed the dose-response relationship between serum levels of 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD) and the occurrence of diabetes mellitus (DM), and we investigated the extent and sources of interstudy heterogeneity. The dose-response relationship between serum TCDD and DM across studies was examined using 2 dependent variables: an exposure level-specific proportion of persons with DM and a corresponding natural log-transformed ratio measure of the association between TCDD and DM. Regression slopes for each dependent variable were obtained for each study and included in a random-effects meta-analysis. Sensitivity analyses were used to assess the influence of inclusion and exclusion decisions, and sources of heterogeneity were explored using meta-regression models and a series of subanalyses. None of the summary estimates in the main models or in the sensitivity analyses indicated a statistically significant association. We found a pronounced dichotomy: a positive dose-response in cross-sectional studies of populations with low-level TCDD exposures (serum concentrations <10 pg/g lipid) and heterogeneous, but on balance null, results for prospective studies of persons with high prediagnosis TCDD body burdens. Considering the discrepancy of results for low current versus high past TCDD levels, the available data do not indicate that increasing TCDD exposure is associated with an increased risk of DM.
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Affiliation(s)
- Michael Goodman
- Correspondence to Dr. Ellen T. Chang, Exponent, Inc., 149 Commonwealth Drive, Menlo Park, CA 94025 (e-mail: ); or Michael Goodman, Department of Epidemiology, Emory University School of Public Health, 1518 Clifton Road, NE, CNR 3021, Atlanta, GA 30322 (e-mail: )
| | | | | | - Ellen T. Chang
- Correspondence to Dr. Ellen T. Chang, Exponent, Inc., 149 Commonwealth Drive, Menlo Park, CA 94025 (e-mail: ); or Michael Goodman, Department of Epidemiology, Emory University School of Public Health, 1518 Clifton Road, NE, CNR 3021, Atlanta, GA 30322 (e-mail: )
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Esteves TMB, Daumas RP, de Oliveira MIC, de Andrade CADF, Leite IC. Factors associated to breastfeeding in the first hour of life: systematic review. Rev Saude Publica 2014; 48:697-708. [PMID: 25210829 PMCID: PMC4181097 DOI: 10.1590/s0034-8910.2014048005278] [Citation(s) in RCA: 77] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2013] [Accepted: 03/07/2014] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVE To identify independent risk factors for non-breastfeeding within the first hour of life. METHODS A systematic review of Medline, LILACS, Scopus, and Web of Science electronic databases, till August 30, 2013, was performed without restrictions on language or date of publishing. Studies that used regression models and provided adjusted measures of association were included. Studies in which the regression model was not specified or those based on specific populations regarding age or the presence of morbidities were excluded. RESULTS The search resulted in 155 articles, from which 18 met the inclusion criteria. These were conducted in Asia (9), Africa (5), and South America (4), between 1999 and 2013. The prevalence of breastfeeding within the first hour of life ranged from 11.4%, in a province of Saudi Arabia, to 83.3% in Sri Lanka. Cesarean delivery was the most consistent risk factor for non-breastfeeding within the first hour of life. "Low family income", "maternal age less than 25 years", "low maternal education", "no prenatal visit", "home delivery", "no prenatal guidance on breastfeeding" and "preterm birth" were reported as risk factors in at least two studies. CONCLUSIONS Besides the hospital routines, indicators for low socioeconomic status and poor access to health services were also identified as independent risk factors for non-breastfeeding within the first hour of life. Policies to promote breastfeeding, appropriate to each context, should aim to reduce inequalities in health.
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Affiliation(s)
- Tania Maria Brasil Esteves
- Centro de Saúde Escola Germano Sinval Faria, Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz, Rio de Janeiro, RJ, Brasil, Centro de Saúde Escola Germano Sinval Faria. Escola Nacional de Saúde Pública Sergio Arouca. Fundação Oswaldo Cruz. Rio de Janeiro, RJ, Brasil
| | - Regina Paiva Daumas
- Centro de Saúde Escola Germano Sinval Faria, Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz, Rio de Janeiro, RJ, Brasil, Centro de Saúde Escola Germano Sinval Faria. Escola Nacional de Saúde Pública Sergio Arouca. Fundação Oswaldo Cruz. Rio de Janeiro, RJ, Brasil
| | - Maria Inês Couto de Oliveira
- Departamento de Epidemiologia e Bioestatística, Instituto de Saúde da Comunidade, Universidade Federal Fluminense, Niterói, RJ, Brasil, Departamento de Epidemiologia e Bioestatística. Instituto de Saúde da Comunidade. Universidade Federal Fluminense. Niterói, RJ, Brasil
| | - Carlos Augusto de Ferreira de Andrade
- Laboratório de Epidemiologia Clínica, Instituto de Pesquisa Clínica Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, RJ, Brasil, Laboratório de Epidemiologia Clínica. Instituto de Pesquisa Clínica Evandro Chagas. Fundação Oswaldo Cruz. Rio de Janeiro, RJ, Brasil
| | - Iuri Costa Leite
- Departamento de Epidemiologia e Métodos Quantitativos, Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz, Rio de Janeiro, RJ, Brasil, Departamento de Epidemiologia e Métodos Quantitativos. Escola Nacional de Saúde Pública Sergio Arouca. Fundação Oswaldo Cruz. Rio de Janeiro, RJ, Brasil
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Longitudinal Trajectories of Health Related Quality of Life in Danish Family Members of Individuals with Severe Brain Injury. AUSTRALIAN JOURNAL OF REHABILITATION COUNSELLING 2013. [DOI: 10.1017/jrc.2013.12] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Scant research has examined health-related quality of life (HRQoL) in family members of patients with severe brain injury, even less has been done in Scandinavian countries, and none has examined this construct longitudinally. The current study therefore used multilevel modelling to investigate the trajectories of HRQoL in 94 Danish family members of patients with severe brain injury at five time points, beginning at the patient's stay in a neuro intensive care unit through one year after injury. The family members’ HRQoL scores significantly and strongly increased over time, and Role Limitations – Emotional scores were higher when patients had high Rancho Los Amigos Scale scores at admission to early intensive rehabilitation in hospital. These results suggest that the acute and sub-acute periods after brain injury are an extremely difficult time psychologically for many families, and family-based mental health interventions during the acute and sub-acute phases are critical, especially for families who have a patient with severe deficits.
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Flink IJE, Restrepo MH, Blanco DP, Ortegon MM, Enriquez CL, Beirens TMJ, Raat H. Mental health of internally displaced preschool children: a cross-sectional study conducted in Bogotá, Colombia. Soc Psychiatry Psychiatr Epidemiol 2013; 48:917-26. [PMID: 23124480 DOI: 10.1007/s00127-012-0611-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2012] [Accepted: 10/12/2012] [Indexed: 10/27/2022]
Abstract
PURPOSE Ongoing armed conflicts, like the one in Colombia, have forcibly displaced millions of people including many young children. This study aimed to assess the mental health of internally displaced preschoolers in Bogotá Colombia and to identify correlates of mental health in these children. METHODS Cross-sectional study conducted among 279 children attending four kindergartens in a deprived neighbourhood in Bogotá. Child mental health was assessed with the Child Behaviour Checklist (CBCL) 1.5-5 years, a parent-report. Univariate analyses and multivariate logistic regressions were performed to assess the association between displacement and child mental health and to identify correlates of mental health in displaced children. RESULTS Displaced children (n = 90) more often met borderline cut-off scores for the CBCL scales than non-displaced children (n = 189) (e.g. total problems 46.7 vs. 22.8 %; p < 0.001). The association between displacement and presence of CBCL total problems remained after adjustment for socio-demographic factors (Adjusted OR 3.3, 95 % CI 1.5; 6.9). Caretaker's mental health partly explained the association. In displaced children, caretaker's mental health (p < 0.01) and family functioning (p < 0.01) were independently associated with child mental health. Exposure to traumatic events and social support was also associated with child mental health; however, associations were not independent. CONCLUSION In this deprived neighbourhood in Bogotá, preschool children registered as internally displaced presented worse mental health than non-displaced peers. Family functioning and caretaker's mental health were strongly and independently associated with displaced children's mental health.
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Affiliation(s)
- Ilse J E Flink
- Department of Public Health, Erasmus University Medical Centre, Room Ae 029, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands.
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Listl S, Moran V, Maurer J, Faggion CM. Dental service utilization by Europeans aged 50 plus. Community Dent Oral Epidemiol 2011; 40:164-74. [DOI: 10.1111/j.1600-0528.2011.00639.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Abstract
PURPOSE To describe variations in chewing abilities of elderly populations in different European countries. METHODS We used data from the Survey of Health, Ageing, and Retirement in Europe (SHARE Wave 2) and estimated a series of multivariate logistic regression models in order to analyse variations in self-reported ability to bite and chew on hard foods by persons aged 50+ from 14 European countries (P < 0.05). RESULTS Abilities to bite and chew on hard foods are comparably high in Sweden, Switzerland and the Netherlands but comparably low in Spain, Denmark, France, Greece, Belgium, Italy, Czechia, and Poland. Median levels are observed in Austria, Germany, and Ireland. CONCLUSIONS The best chewing abilities seem to exist amongst elderly populations in Sweden, Switzerland, and the Netherlands but comparably low chewing abilities appear to prevail amongst those in Spain, Denmark, France, Greece, Belgium, Italy, Czechia, and Poland. Future research is encouraged to identify the exact causes and consequences of such disparities in oral health.
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Affiliation(s)
- Stefan Listl
- Department of Conservative Dentistry, University of Heidelberg, Heidelberg, Germany University of Mannheim, Mannheim Research Institute for the Economics of Aging (MEA), Mannheim, Germany.
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Abstract
The purpose of this study was to describe income-related inequalities in dental service utilization by the elderly populations residing in different European countries. We used data from the Survey of Health, Ageing, and Retirement in Europe (SHARE Wave 2), which contains information on utilization of dental services by 33,358 individuals aged 50+ years from 14 different countries. We assessed income-related inequalities in dental attendance and preventive and/or operative dental treatment by means of Concentration Indices (CI) and Slope Indices of Inequality (SII). We could identify a disproportionate concentration of access to treatment among the rich elderly populations in all 14 countries (relative inequality according to CI), as well as significantly higher access to treatment by individuals located in the highest in relation to the lowest income group for all countries except Italy and the Czech Republic (absolute inequality according to SII). Such differential utilization appears mainly attributable to inequalities in preventive dental visits, either alone or in combination with operative treatment. Persons' oral health status explains substantial proportions of absolute but not of relative inequalities. Overall, there is considerable income-related inequality in dental service utilization by several elderly populations residing in Europe. More research is needed to identify the exact causes of such disparities.
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Affiliation(s)
- S Listl
- Department of Conservative Dentistry, University of Heidelberg, Mannheim Research Institute for the Economics of Aging.
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Schreinemachers DM. Perturbation of lipids and glucose metabolism associated with previous 2,4-D exposure: a cross-sectional study of NHANES III data, 1988-1994. Environ Health 2010; 9:11. [PMID: 20187939 PMCID: PMC2848015 DOI: 10.1186/1476-069x-9-11] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2009] [Accepted: 02/26/2010] [Indexed: 05/19/2023]
Abstract
BACKGROUND Results from previous population studies showed that mortality rates from acute myocardial infarction and type-2 diabetes during the 1980s and 1990s in rural, agricultural counties of Minnesota, Montana, North and South Dakota, were higher in counties with a higher level of spring wheat farming than in counties with lower levels of this crop. Spring wheat, one of the major field crops in these four states, was treated for 85% or more of its acreage with chlorophenoxy herbicides. In the current study NHANES III data were reviewed for associations of 2,4-dichlorophenoxy acetic acid (2,4-D) exposure, one of the most frequently used chlorophenoxy herbicides, with risk factors that are linked to the pathogenesis of acute myocardial infarction and type-2 diabetes, such as dyslipidemia and impaired glucose metabolism. METHODS To investigate the toxicity pattern of chlorophenoxy herbicides, effects of a previous 2,4-D exposure were assessed by comparing levels of lipids, glucose metabolism, and thyroid stimulating hormone in healthy adult NHANES III subjects with urinary 2,4-D above and below the level of detection, using linear regression analysis. The analyses were conducted for all available subjects and for two susceptible subpopulations characterized by high glycosylated hemoglobin (upper 50th percentile) and low thyroxine (lower 50th percentile). RESULTS Presence of urinary 2,4-D was associated with a decrease of HDL levels: 8.6% in the unadjusted data (p-value = 0.006), 4.8% in the adjusted data (p-value = 0.08), and 9% in the adjusted data for the susceptible subpopulation with low thyroxine (p-value = 0.02). An effect modification of the inverse triglycerides-HDL relation was observed in association with 2,4-D. Among subjects with low HDL, urinary 2,4-D was associated with increased levels of triglycerides, insulin, C-peptide, and thyroid stimulating hormone, especially in the susceptible subpopulations. In contrast, subjects with high HDL did not experience adverse 2,4-D associated effects. CONCLUSIONS The results indicate that exposure to 2,4-D was associated with changes in biomarkers that, based on the published literature, have been linked to risk factors for acute myocardial infarction and type-2 diabetes.
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Affiliation(s)
- Dina M Schreinemachers
- Epidemiology Branch, Environmental Public Health Division, National Health and Environmental Effects Research Laboratory, Office of Research and Development, US Environmental Protection Agency, 109 TW Alexander Drive, Research Triangle Park, NC 27711, USA.
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Garcia-Aymerich J, Serra I, Gómez FP, Farrero E, Balcells E, Rodríguez DA, de Batlle J, Gimeno E, Donaire-Gonzalez D, Orozco-Levi M, Sauleda J, Gea J, Rodriguez-Roisin R, Roca J, Agustí ÀG, Antó JM. Physical Activity and Clinical and Functional Status in COPD. Chest 2009; 136:62-70. [DOI: 10.1378/chest.08-2532] [Citation(s) in RCA: 112] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Adjusting for reverse causality in the relationship between obesity and mortality. Int J Obes (Lond) 2008; 32 Suppl 3:S42-6. [PMID: 18695652 DOI: 10.1038/ijo.2008.84] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Garcia-Aymerich J, Félez MA, Escarrabill J, Marrades RM, Morera J, Elosua R, Antó JM. Physical activity and its determinants in severe chronic obstructive pulmonary disease. Med Sci Sports Exerc 2005; 36:1667-73. [PMID: 15595285 DOI: 10.1249/01.mss.0000142378.98039.58] [Citation(s) in RCA: 92] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
BACKGROUND Patients with chronic obstructive pulmonary disease (COPD) have a limited exercise capacity. Surprisingly, little is known about their levels of physical activity practice. We assessed the levels and determinants of physical activity practice in severe COPD patients. METHODS A cross-sectional systematic sample of 346 COPD patients was recruited during 1 yr in four tertiary hospitals of the Barcelona area of Spain. Patients answered a questionnaire, which included physical activity assessment, and performed spirometric tests and blood gases. RESULTS Seventy-eight percent of patients walked daily whereas 17% did not practice any physical activity. Median energy expenditure in physical activity was 109 kcal x d(-1) (IQR 24-239). The following factors were independently associated with a lower physical activity level in a logistic regression analysis: female sex (OR 2.92, 95% CI 1.11-7.70), older age (1.04, 1.01-1.07 per year), higher socioeconomic status (2.23, 1.24-4.02), diabetes (2.66, 1.40-5.06), lower physical and mental quality of life (0.93, 0.90-0.96 and 0.96, 0.93-0.98, respectively, per unit), and long-term oxygen therapy (2.07, 1.19-3.60). Neither FEV1, previous COPD admissions, body mass index, nor other treatments were related to physical activity practice. CONCLUSIONS In conclusion, one third of severe COPD patients in our study reported a level of physical activity lower than the equivalent to walking less than 15 min x d(-1). Apart from sociodemographic variables, comorbidity, health-related quality of life, and long-term oxygen therapy were the only factors independently associated with a low level of physical activity.
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Affiliation(s)
- Judith Garcia-Aymerich
- Respiratory and Environmental Health Research Unit, Municipal Institute of Medical Research (IMIM), Barcelona, Spain.
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Vianna MIP, Santana VS. Exposição ocupacional a névoas ácidas e alterações bucais: uma revisão. CAD SAUDE PUBLICA 2001. [DOI: 10.1590/s0102-311x2001000600004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Neste estudo de revisão, sistematizam-se os achados de pesquisas sobre os efeitos das exposições ocupacionais a névoas ácidas na saúde bucal. Utilizaram-se como bases de dados MEDLINE, LILACS, SciELO, BBO e DEDALUS, das quais foram selecionados oito artigos e uma tese de doutorado, que focalizavam as associações de interesse. Os achados são consistentes em torno de uma associação positiva entre exposição a névoas ácidas e erosão dental, confirmando os dados de pesquisas conduzidas desde 1919. Estudos sobre a associação entre névoas ácidas e a doença periodontal ou lesões da mucosa oral são mais recentes e raros, e os achados, controversos. Muitos estudos apresentam limites metodológicos, especialmente tamanho insuficiente da população de estudo, e análise apenas descritiva, ou sem a consideração de variáveis de confusão. A importância deste tema revela-se no grande número de trabalhadores potencialmente expostos e na necessidade da incorporação de aspectos da saúde bucal no campo da saúde do trabalhador, a fim de que programas de prevenção efetivos possam ser implementados.
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Michalek JE, Ketchum NS, Longnecker MP. Serum dioxin and hepatic abnormalities in veterans of Operation Ranch Hand. Ann Epidemiol 2001; 11:304-11. [PMID: 11399444 DOI: 10.1016/s1047-2797(00)00218-0] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE We studied hepatic abnormalities and indices of hepatic function in relation to exposure to 2,3,7,8-tetrachlorodibenzo-p-dioxin (dioxin) in veterans of Operation Ranch Hand, the Air Force unit responsible for the aerial spraying of herbicides in Vietnam from 1962 to 1971. METHODS The prevalence of ever having liver disease through March 1993, and level of alanine aminotransferase, aspartate aminotransferase, gamma-glutamyltransferase (GGT), lactic dehydrogenase (LDH), alkaline phosphatase, and total bilirubin were examined according to serum dioxin levels. RESULTS We found an increased risk of "other liver disorders" among veterans with the highest dioxin levels [adjusted odds ratio (OR) = 1.6, 95% confidence interval (CI) 1.2 to 2.1], due primarily to increased transaminases or LDH (adjusted OR = 2.7, 95% CI 1.4 to 5.1) and to other nonspecific liver abnormalities (adjusted OR = 1.4, 95% CI 1.0 to 2.0). CONCLUSIONS Whether the associations observed were causal is unclear from these data.
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Affiliation(s)
- J E Michalek
- Air Force Research Laboratory, Brooks AFB, TX, USA
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Affiliation(s)
- P M Simpson
- Department of Pediatrics, University of Arkansas, Little Rock, Arkansas, USA
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Shadel BN, Evans RG, Roberts DW. The reliability of 2,3,7,8-tetrachlorodibenzo-p-dioxin and toxicity equivalence measurements in Missouri residents. CHEMOSPHERE 2000; 40:1089-1094. [PMID: 10739050 DOI: 10.1016/s0045-6535(99)00357-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
This study evaluates the reliability of serum measurements of 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD) and toxicity equivalence (TEQ) in individuals with no prior exposure to TCDD or dioxin-like compounds above background levels. Reliability was measured over three time-periods in the same individuals. TCDD and TEQ were measured in 127 and 128 participants. The values declined during the testing periods. Reliability coefficients for TCDD was 0.69 and for TEQ 0.91 but increased to 0.79 and 0.92, respectively, after removal of three outlying cases. Study results show good reliability over 22 months suggesting a consistency in the uptake and excretion of TCDD and other dioxin-like compounds.
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Affiliation(s)
- B N Shadel
- School of Public Health, Division of Environmental and Occupational Health, Saint Louis University, MO 63108, USA
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Lampi P, Vohlonen I, Tuomisto J, Heinonen OP. Increase of specific symptoms after long-term use of chlorophenol polluted drinking water in a community. Eur J Epidemiol 2000; 16:245-51. [PMID: 10870939 DOI: 10.1023/a:1007622317866] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Chlorophenols contaminated the drinking water system and a local lake in the village of Järvelä in southern Finland. Period prevalence rates of symptoms, signs and diseases among the residents 15 years or older who responded (69%) to a survey in the contaminated area (1773 subjects) were compared with the rates of three uncontaminated areas (2018 subjects). Gastrointestinal and skin symptoms, in particular, were significantly (p < 0.05) more common in the contaminated area than in each control area. Nausea, general malaise, headache, anorexia, exceptional tiredness, and respiratory infections were significantly increased compared to the control areas combined. A dose-response was also observed: higher consumption of drinking water and contaminated fish further significantly increased (p < 0.05) reported symptoms. In conclusion, long-term use of chlorophenol polluted household water and fish can cause symptoms already familiar in connection with occupational chlorophenol exposures.
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Affiliation(s)
- P Lampi
- National Public Health Institute, Division of Environmental Health, Kuopio, Finland
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Longnecker MP, Michalek JE. Serum dioxin level in relation to diabetes mellitus among Air Force veterans with background levels of exposure. Epidemiology 2000; 11:44-8. [PMID: 10615842 DOI: 10.1097/00001648-200001000-00010] [Citation(s) in RCA: 116] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Data from several epidemiologic studies suggest that exposure to unusually high amounts of dioxin (2,3,7,8-tetrachlorodibenzo-p-dioxin) increases the risk of diabetes mellitus, and experimental data suggest that the mechanism for this is decreased cellular glucose uptake. To investigate the dose-response relation more closely, we examined the association of serum dioxin level with prevalence of diabetes mellitus and with levels of serum insulin and glucose among 1,197 veterans in the Air Force Health Study who never had contact with dioxin-contaminated herbicides and whose serum dioxin level was within the range of background exposure typically seen in the United States (< or =10 ng/kg lipid). Compared with those whose serum dioxin level was in the first quartile (<2.8 ng/kg lipid), the multivariate-adjusted odds of diabetes among those in the highest quartile (> or =5.2 ng/kg lipid) was 1.71 (95% confidence interval = 1.00-2.91). The association was slightly attenuated after adjustment for serum triglycerides. Whether adjustment for serum triglycerides was appropriate, however, cannot be determined with available data. The association of background-level dioxin exposure with the prevalence of diabetes in these data may well be due to reasons other than causality, although a causal contribution cannot be wholly dismissed.
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Affiliation(s)
- M P Longnecker
- Epidemiology Branch, National Institute of Environmental Health Sciences, Research Triangle Park, NC 27709, USA
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Abstract
The hypothesis that occupational noise exposure is positively associated with hypertension was examined in a cross-sectional study carried out on a group of patients who were enrolled at the Occupational Health Unit of the Unified Health System, situated in Salvador city, the capital of Bahia state, Brazil. Data were obtained from 276 medical records, corresponding to all patients newly registered during the first six months of 1992. Data on noise exposure come from both reported occupational exposure history and clinical diagnosis of occupational noise-induced hearing loss. Hypertension diagnosis complies with World Health Organization criteria, as well as with the history of antihypertensive treatment. Stratified analysis and unconditional logistic regression modeling show results that do not support the study hypothesis: there are no differences between systolic or diastolic blood pressure or between proportion of hypertension for exposed and non exposed groups. However, statiscally significant (alpha = 0.05) increment of the effect measured was reported among workers who reported low educational level (below elementary). This could be another evidence of socially related inequalities underlying exposure distribution among workers at the workplace, which should be addressed, at greater depth, in future studies.
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Affiliation(s)
- V S Santana
- Instituto de Saúde Coletiva da Universidade Federal da Bahia, Salvador, Brasil.
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Dayal HH, Baranowski T, Li YH, Morris R. Hazardous chemicals: psychological dimensions of the health sequelae of a community exposure in Texas. J Epidemiol Community Health 1994; 48:560-8. [PMID: 7830010 PMCID: PMC1060033 DOI: 10.1136/jech.48.6.560] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
STUDY OBJECTIVE A chemical spill from an oil refinery exposed the local community to more than 40,000 lb of highly toxic and corrosive hydrofluoric acid. A community based symptom prevalence study found an association between exposure and physical symptoms: the psychological impact of the disaster and its potential effect on the reporting of physical symptoms is examined here. DESIGN The study used a population based survey design consisting of two phases: phase I, the exposure phase, and, phase II, the symptom prevalence phase. SUBJECTS In phase I, information indicative of exposure was collected on 10,811 individuals in a door to door survey of a geographically defined area. In phase II, symptom prevalence information was gathered through in-person interviews with 2509 subjects selected from the phase I census in a sampling scheme that balanced across the exposure categories with regard to age, gender, and predisposition. The refusal rate in both phases was < 5%. MEASUREMENT AND MAIN RESULTS Stepwise logistic regression analyses were used to assess the relative predictive importance of psychological variables and hydrofluoric acid exposure in explaining the reported physical symptoms two years after the disaster. The findings show a linear relationship between the level of hydrofluoric acid exposure and the degree of psychological stress two years after the accident. High exposure had a long term (more than two years) impact on physical health for some self reported symptoms, even after controlling for the psychological impact. Some physical symptom reports, however, were better explained by psychological status than by exposure to hydrofluoric acid. The physical symptoms for which exposure was the major predictor were those for which the biological plausibility of a relationship with hydrofluoric acid exposure was direct. CONCLUSIONS Measures of psychological status should be included in symptom studies of health sequelae to man-made disasters so that the physical effects of exposure can be more accurately assessed.
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Affiliation(s)
- H H Dayal
- University of Texas, Medical Branch of Galveston, Texas 77555-1009
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Lee J, Chia KS. Estimation of prevalence rate ratios for cross sectional data: an example in occupational epidemiology. BRITISH JOURNAL OF INDUSTRIAL MEDICINE 1993; 50:861-2. [PMID: 8398881 PMCID: PMC1061320 DOI: 10.1136/oem.50.9.861] [Citation(s) in RCA: 63] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
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